| Name: | Coosa Eye Associates, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 26 Mar 1990 (35 years ago) |
| Date of dissolution: | 12 Jul 2024 |
| Entity Number: | 000-136-126 |
| Register Number: | 000136126 |
| Place of Formation: | Talladega County |
| Registered Office Street Address: | HWY 280 MEDICAL-SURGICAL CENTERCHILDERSBURG, AL |
| Authorized Capital: | 3,000 NPV |
| Paid Share Capital: | $1,000 |
Activities
OPTOMETRY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1053488544 | 2006-11-29 | 2012-03-06 | PO BOX J, CHILDERSBURG, AL, 350440510, US | 34011 US HIGHWAY 280, CHILDERSBURG, AL, 350442128, US | |||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||
| Phone | +1 256-378-5507 |
| Fax | 2563785325 |
Authorized person
| Name | P. DUNCAN ROY JR. |
| Role | OWNER |
| Phone | 2563785507 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | S-471-TA-079 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS |
| Number | 510-59662 |
| State | AL |
| Issuer | MEDICAID |
| Number | 000059662 |
| State | AL |
| Issuer | MEDICARE ID |
| Number | 102G703418 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| ROY, P DUNCAN JR | Agent | 36 WOODSIDE STREETCHILDERSBURG, AL 35044 |
| Name | Role | Address |
|---|---|---|
| ROY, P DUNCAN JR | Incorporator | 36 WOODSIDE STREETCHILDERSBURG, AL 35044 |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 1990-10-18 | Capital Change | 1,000 NPV Authorized $1,000 Paid In | 3,000 NPV Authorized $1,000 Paid In |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
